Patient In Grief Health Care Dealing with Grief
Grief is a universal human experience that can have profound effects on an individual’s physical, emotional, and mental well-being. In health care settings, grief often accompanies death, terminal illness, and significant losses, making it a critical area for nursing practice and research. This article explores the definition of grief, terms related to grief, the role of nurses in managing grief, the implications of grief related to death and terminal illness, standardized instruments for grief assessment, manifestations of grief, variables in grief research, descriptive studies, and the consequences of grief.
What is Grief?
Grief is a complex and multifaceted response to the loss of a significant person, object, belief, relationship, body part, or function. It encompasses an entire range of physical, psychological, cognitive, and behavioral reactions to loss. Grief is typically characterized by intense emotional suffering, and its duration can vary from weeks to years, depending on the individual and the nature of the loss.
Three main types of grief have been identified:
- Conventional Grief: Occurs after a loss and follows what is often considered a “normal” pattern of grieving.
- Anticipatory Grief: Involves grieving in response to an impending loss, such as in the case of terminal illness. Anticipatory grief is believed to help individuals cope with the actual loss when it occurs.
- Pathological Grief: Grief that deviates from what is considered a normal grieving process. Although there are no specific criteria to distinguish pathological grief from conventional grief, it typically refers to prolonged or severely debilitating grief.
Grief is an intensely personal experience, and each person may express it differently. While some may exhibit outward signs of distress, others may internalize their emotions or exhibit behaviors that mask their grief.
Terms Related to Grief
Several terms are closely associated with the concept of grief, including loss, bereavement, and mourning. These terms are often used interchangeably but have distinct meanings:
- Loss: The experience of parting with something valued, such as a person, object, or relationship. Loss necessitates a reorganization of the individual’s life, with losses ranging from minor (e.g., the loss of a job) to major (e.g., the death of a loved one).
- Bereavement: Refers to the state of having experienced a loss, especially the death of someone significant. Bereavement is often accompanied by grief, but the intensity and duration of grief may vary.
- Mourning: Refers to the socially prescribed behaviors following a significant loss, particularly death. Mourning rituals and practices vary widely across cultures and do not necessarily indicate the intensity or presence of internal grief.
Grief and Nursing Role
Nurses play a critical role in managing grief across various health care settings, including emergency departments, intensive care units, labor and delivery units, and psychiatric care facilities. Nurses often serve as the primary caregivers to individuals and families experiencing grief, whether due to anticipatory grief related to terminal illness or conventional grief following a death or loss.
Despite the significance of grief in nursing practice, little nursing research focused on grief until the late 1980s. In the decades since, the role of nurses in supporting grieving patients and families has become an important area of study. Nurses are often at the frontline of care, providing not only physical care but also emotional support to those coping with grief.
Nurses’ unique position allows them to observe the grieving process firsthand and intervene when necessary. They are often tasked with helping patients and their families navigate grief, whether it is due to a terminal diagnosis or the loss of a loved one. This role requires nurses to develop skills in empathy, communication, and emotional support to help those in grief cope effectively.
Death Grief or Terminal Illness
Grief associated with death and terminal illness has been a significant focus of nursing research since the 1980s. In 1983, Jeanne Quint Benoliel conducted a review of nursing research on death, dying, and terminal illness, highlighting the need for more research in these areas. Since then, numerous studies have explored the experiences of individuals facing terminal illness and those who are grieving after a death.
In 1987, Demi and Miles published a review on bereavement, followed by Opie’s 1992 review on childhood and adolescent bereavement. In 1995, Martinson reviewed research on pediatric hospice care, focusing on both anticipatory grief and grief after the death of a child. Additionally, Corless (1994) critiqued research on symptom control in hospice care and reviewed studies on coping with dying.
Several nurse researchers, including J.Q. Benoliel, R. Constantino, A. Demi, M. Diamond, N. Hogan, M. Miles, S. Murphy, J. Saunders, and M. Vachon, have contributed to the growing body of research on grief. More recently, Hogan and Schmidt (2002) developed a model of grief to personal growth using structural equation modeling, providing further insights into the grieving process.
Standardized Instruments for Grief Assessment
Several standardized instruments have been developed to assess grief and its manifestations. These tools help researchers and clinicians measure the emotional, psychological, and behavioral aspects of grief. Some commonly used instruments include:
- Texas Inventory of Grief: Measures the intensity and duration of grief responses.
- Grief Experience Inventory: Assesses various dimensions of grief, including emotional, cognitive, and behavioral responses.
- Bereavement Experience Questionnaire: Evaluates the experiences of individuals who have experienced a significant loss.
In addition, emotional distress accompanying grief is often measured using tools such as the Brief Symptom Inventory, the Profile of Mood States, the Impact of Events Questionnaire, or depression scales like Beck’s or Hamilton’s.
For children and adolescents, the Child Behavior Checklist is commonly used to assess grief. A more recent addition to the field is the Hogan Grief Reaction Checklist (Hogan, Greenfield, & Schmidt, 2001), which provides a comprehensive assessment of grief reactions.
Manifestations of Grief
Nursing research on bereavement has focused on understanding the various manifestations of grief among different populations. These include bereaved parents, children, siblings, widows, survivors of suicide, and individuals facing terminal illness. Studies have also examined grief responses to events such as the loss of a home by fire or a miscarriage.
Research in this area often employs diverse analytical approaches, such as grounded theory and phenomenology, and uses various data collection methods, including participant observation, semi-structured interviews, survey questionnaires, and structured instruments. These methods provide a comprehensive understanding of how grief is experienced across different settings and populations.
Variables in Grief Research
Several variables influence the outcomes of bereavement, including self-blame, coping processes, and social support. Nursing research has explored these variables to understand their impact on how individuals navigate the grieving process.
For example, studies have investigated the effects of support groups on bereaved parents, children, and adolescents, as well as the impact of grief workshops for nurses working in pediatric oncology. These interventions aim to provide individuals with the tools they need to manage their grief and cope with loss.
A few studies have used quasi-experimental designs to investigate the effectiveness of specific interventions for the bereaved. These studies highlight the importance of tailored support systems that address the unique needs of individuals experiencing grief.
Descriptive Studies and Meaning of Grief
Descriptive studies have greatly enhanced our understanding of the grief process and its various manifestations. These studies provide insight into the many forms grief can take, offering a nuanced view of how different individuals experience and express their grief. Comparative and correlational studies have also contributed valuable knowledge, particularly by identifying the variables that influence bereavement outcomes.
However, more research is needed to assess the effectiveness of interventions designed to help individuals cope with grief. Most existing research has focused on White American populations, highlighting the need for more studies that address grief in culturally diverse groups. Fortunately, a few researchers have begun to explore cultural differences in bereavement. For example, Lee and Chu (2001) studied the grief of Chinese men diagnosed with infertility, and Van and Meleis (2003) examined African American women’s grief after involuntary pregnancy loss.
Researchers should continue to develop culturally relevant instruments for assessing bereavement outcomes to ensure that diverse populations receive appropriate support.
Consequences of Grief
Grief can have significant consequences on an individual’s well-being. People who are grieving are often vulnerable and may require special attention to protect them from further emotional harm. While some grieving individuals find it therapeutic to participate in research, sharing their experiences with a compassionate researcher, there is also the risk of exacerbating their emotional pain.
Researchers conducting studies on grief must be skilled in providing immediate emotional support and should be prepared to refer participants for counseling if needed. Understanding the potential consequences of grief is essential for developing effective interventions and ensuring that individuals receive the care they need during this difficult time.
Conclusion
Grief is a multifaceted experience that requires careful consideration in health care settings. Nurses play a crucial role in supporting individuals and families through the grieving process, whether in the context of terminal illness, sudden death, or other significant losses. As nursing research on grief continues to evolve, it is essential to develop culturally sensitive interventions and tools for assessing grief, ensuring that diverse populations receive the care and support they need.